Comparison of Ventilatory Effects of Ultrasound-Guided Versus Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy

Comparison of the Effects of Percutaneous Dilatational Tracheostomy Performed With Fiberoptic Bronchoscopy and Ultrasound Guidance on Ventilation

Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in intensive care units for patients requiring prolonged mechanical ventilation. Fiberoptic bronchoscopy (FOB) and ultrasonography (USG) are frequently used to guide PDT in order to improve procedural safety. However, the effects of these guidance techniques on ventilation parameters during the procedure remain unclear.

This retrospective observational study aims to compare the effects of FOB-guided and USG-guided percutaneous dilatational tracheostomy on ventilation parameters in mechanically ventilated adult intensive care unit patients. Changes in arterial blood gas parameters and ventilator settings during and after the procedure will be evaluated.

The findings of this study may help clinicians better understand the physiological effects of different PDT guidance techniques and support informed decision-making in clinical practice.

Study Overview

• Status: Completed
• Conditions: Tracheostomy; Respiratory Failure; Mechanical Ventilation
• Intervention / Treatment: Procedure: Percutaneous Dilatational Tracheostomy Guidance Method

Detailed Description

Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units (ICUs) as an alternative to surgical tracheostomy in patients requiring prolonged mechanical ventilation. Various guidance methods have been introduced to increase procedural safety and accuracy, including fiberoptic bronchoscopy (FOB) and ultrasonography (USG). While both techniques are commonly used, their effects on ventilation and gas exchange during the procedure are still debated.

Fiberoptic bronchoscopy allows direct visualization of the tracheal lumen and needle placement but may partially obstruct the airway, potentially leading to increased airway pressures, hypercapnia, and impaired ventilation. Ultrasonography, on the other hand, enables real-time visualization of neck anatomy without entering the airway and may therefore have different effects on ventilation parameters.

This retrospective observational study includes adult ICU patients who underwent percutaneous dilatational tracheostomy between May 5, 2023, and September 1, 2025. Patients were grouped according to the guidance technique used during the procedure: FOB-guided PDT or USG-guided PDT. All procedures were performed under standard ICU conditions by experienced clinicians.

Demographic data, clinical characteristics, ventilator settings, and arterial blood gas parameters were collected from patient records. Primary outcomes included changes in arterial blood gas values (pH, PaCO₂, PaO₂) and ventilatory parameters before, during, and after the procedure. Secondary outcomes included procedure duration and procedure-related complications.

The study aims to compare the effects of FOB-guided and USG-guided PDT on ventilation and gas exchange, providing insight into the physiological consequences of each technique. As a retrospective observational study, no additional interventions were performed beyond standard clinical practice.

The results of this study may contribute to optimizing guidance method selection during percutaneous dilatational tracheostomy and improving patient safety in the intensive care setting.

• Study Type: Observational
• Enrollment (Actual): 77

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Sisli
    • Istanbul, Sisli, Turkey (Türkiye), 34384
      • Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult intensive care unit patients who required prolonged invasive mechanical ventilation and underwent percutaneous dilatational tracheostomy guided by either fiberoptic bronchoscopy or ultrasonography as part of routine clinical practice.

Description

Inclusion Criteria:

Adult patients (≥18 years of age) Patients admitted to the intensive care unit Patients receiving invasive mechanical ventilation Patients who underwent percutaneous dilatational tracheostomy under fiberoptic bronchoscopy or ultrasonography guidance Availability of complete clinical and arterial blood gas data

Exclusion Criteria:

Age <18 years Patients with incomplete medical records or missing arterial blood gas data Patients who underwent surgical (open) tracheostomy Patients with pre-existing tracheal pathology affecting ventilation parameters

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Fiberoptic Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy; Adult ICU patients who underwent percutaneous dilatational tracheostomy guided by fiberoptic bronchoscopy as part of routine clinical practice.	Procedure: Percutaneous Dilatational Tracheostomy Guidance Method; Percutaneous dilatational tracheostomy performed under either fiberoptic bronchoscopy or ultrasonography guidance according to routine clinical practice. No interventions were assigned by study protocol.
Ultrasonography-Guided Percutaneous Dilatational Tracheostomy; Adult ICU patients who underwent percutaneous dilatational tracheostomy guided by ultrasonography as part of routine clinical practice.	Procedure: Percutaneous Dilatational Tracheostomy Guidance Method; Percutaneous dilatational tracheostomy performed under either fiberoptic bronchoscopy or ultrasonography guidance according to routine clinical practice. No interventions were assigned by study protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Ventilation and Arterial Blood Gas Parameters During Percutaneous Dilatational Tracheostomy	Changes in arterial blood gas parameters (pH, PaCO₂, PaO₂) and ventilatory parameters measured before, during, and after percutaneous dilatational tracheostomy, comparing fiberoptic bronchoscopy-guided and ultrasonography-guided procedures.	Immediately before the procedure, during the procedure, and immediately after the procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Procedure Duration	Total duration of the percutaneous dilatational tracheostomy procedure, measured from skin incision to successful tracheostomy tube placement.	During the procedure
Procedure-Related Complications	Incidence of procedure-related complications, including hypoxia, hypercapnia, bleeding, hypotension, pneumothorax, and other clinically relevant adverse events.	During the procedure and the immediate post-procedural period

Collaborators and Investigators

• Sponsor: Prof. Dr. Cemil Tascıoglu Education and Research Hospital Organization

Study record dates

Study Major Dates

• Study Start (Actual): September 15, 2025
• Primary Completion (Actual): October 15, 2025
• Study Completion (Actual): October 15, 2025

Study Registration Dates

• First Submitted: January 22, 2026
• First Submitted That Met QC Criteria: January 22, 2026
• First Posted (Actual): January 29, 2026

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 22, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Intensive Care Unit; Mechanical Ventilation; Ultrasonography; Fiberoptic Bronchoscopy; Arterial Blood Gas; Percutaneous Dilatational Tracheostomy; Ventilation Parameters
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Respiratory Insufficiency
• Other Study ID Numbers: CT-ERHO-AR-BA-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No